PROJECT SUMMAY / ABSTRACT BACKGROUND: The US Public Health Service (USPHS) designated tobacco dependence as a chronic disease. This is especially true for smokers with serious mental illness (SMI) who make more cessation attempts and are less successful sustaining long-term abstinence than the general population. There is a significant health disparity wherein individuals with SMI have a higher tobacco use prevalence and a greater risk for tobacco-related mortality than the general population. Chronic care models suggest chronic disease management requires a multidisciplinary care team to assess tobacco use, administer treatment, support patient self-management, and monitor progress. Proactive telephone outreach to smokers and brief provider interventions are two effective chronic disease management strategies. Community based mental health centers (CMHCs) are a primary treatment access point for many smokers with SMI. However, rates of intervention with smoking by CMHC providers are low. In order to implement the chronic care model for tobacco dependence for CMHCs, comprehensive implementation strategies are needed. OBJECTIVE: In response to PAR-18-223 we propose formative research and a feasibility pilot trial to adapt an implementation strategy developed by the SAMHSA-funded network of Addiction Technology Transfer Centers (ATTCs) to integrate a proactive, chronic care model of tobacco cessation treatment into CMHCs.
AIMS : This study has 3 aims: (1) Adapt an evidence-based implementation strategy to CMHCs. (2) Pilot test the implementation strategy. (3) Conduct a pilot trial to assess the feasibility, acceptability and initial effectiveness of the implementation strategy. DESIGN: In A1, we will conduct stakeholder interviews of 22-29 patients, providers and site leaders in 4 CMHCs guided by the Practical, Robust Implementation and Sustainability Model to obtain information about adapting the ATTC science to service laboratory (SSL) implementation strategy. In A2 we will pilot the SSL strategy to implement proactive tobacco-related telephone outreach calls plus brief provider intervention in one CMHC (N=25 patients; N=33-50 providers) to obtain information on feasibility and acceptability over a 3-month implementation period. In A3 we will conduct a pilot hybrid type 2 implementation-effectiveness trial in 3 CMHCs (N=50 patients; 96-130 providers). We will conduct 2 baseline assessments (3 months apart) and outcomes will be assessed at 3, 6, and 12-months post implementation. Outcomes include feasibility, acceptability, effectiveness of the implementation strategy on tobacco cessation treatment utilization (counseling and medication) and patient effectiveness on tobacco cessation (CO confirmed 7-day point prevalence abstinence). SIGNIFICANCE: An effective implementation strategy for tobacco cessation treatment in CMHCs, a widespread model of care delivery, would have enormous public health impact.
There is a significant disparity in tobacco use by mental illness in that smokers with mental illness are more likely to use tobacco and contract smoking related disease. Implementation strategies are needed to implement effective tobacco treatment into mental health treatment settings including community based mental health centers. The proposed study adapts the Addiction Technology Transfer Centers Science to Service Laboratory implementation strategy to implement proactive, chronic care based tobacco cessation treatment strategy into community-based mental health centers.
